Jun 21 I Am One Face of Postpartum Anxiety

I want to bring awareness to Postpartum Anxiety (PPA) because even though I hired a doula, took a childbirth education class, and work in the mental health field, I had no idea PPA was even a thing. I was very aware of Postpartum Depression (PPD) as well as the extremely rare Postpartum Psychosis, so when I started having symptoms that I couldn’t explain with either of those, I did a simple Google search: anxiety after having a baby. What do you know? PPA is a thing.

If you asked most people who interacted with me after I had Riley, they might say that I seemed anxious, but that it was understandable given my experience of Riley getting sick (read more here). However, I was SO ashamed at just how debilitated I was, that I only gave a glimpse of what was going on. “I’m feeling a little anxious,” or “I’m still pretty nervous,” were my canned responses when someone asked how I was doing. Russell and my boss were probably the most tuned-in to the fact that something was very wrong. Since Russell lives with me and my boss is a psychologist, it's not surprising that they picked up on it. Everyone wanted me to be happy after I had Riley, but to put it lightly, it was difficult for me to feel happiness when my days were spent filled with dread.

What did PPA look like for you? PPA is an incredibly dynamic disorder, and from what I’ve learned, each person experiences it differently. For me, it looked a lot like this:

1.I had an intense, debilitating fear that Riley was going to die. I had seen her stop breathing and that reality felt all too fresh. Pediatricians, NICU nurses, family members, and friends told me that once the hospital released her, we should have 100% faith that she was a healthy baby girl. I had zero faith in that, and was convinced that at any moment she would stop breathing again. Even the thought of leaving her to use the restroom gave me distress. I had vivid images in my mind of returning to a lifeless baby after my thirty-second trip to the bathroom. I’d plan my bathroom trips around visitors and Russell being home so that Riley was never unattended. However, I also didn’t trust that others would check her as often or monitor her as closely as I did because in my mind, no one else realized just how fragile her life was. Looking back, of course they didn’t. They thought she was healthy, and I was convinced she wasn’t.

2.I experienced intrusive thoughts that if I didn’t check Riley a certain number of times in an hour, I would miss the signs that something was wrong and she would become progressively sicker and probably die. I needed to ask if Riley was OK at least every minute when someone else was holding her – particularly Russell. I tried to hide this need when others were around, and in trying to suppress this behavior, I felt a great deal of distress. I would sweat and panic - my heart would race. I’d try to distract myself but I’d have to ask. “Is she ok?” or “Is she breathing?” When Russell was around and we were with others, I would make eye contact with him privately and he knew I was checking in – he’d nod if he could see she was breathing. This level of trust (relying on him to tell me that she was okay in front of company), caused a great deal of panic and only happened comfortably after I began therapy.

3.I had extreme fear of leaving my home with Riley, so I didn’t. For Riley and I to take a walk around the block took weeks, and I cried most of the way the first time. I was filled with terror that we would be out, Riley would stop breathing, and I wouldn’t be able to help her in time. Maybe I thought I’d be too distracted by being outside, or that all of the straps in the car seat would take too long to unhook and get to her. My mind was working overtime, and any possible situation played out repeatedly, leaving me isolated, ashamed, and lonely. When I did leave home, a severe amount of physical and mental distress (inability to think clearly, irritability, weepiness, fear, heart racing, fast breathing, sense of dread, sweating, etc) completely took over.

4.I couldn’t sleep when sleep was possible. Having a newborn is exhausting and sleep is a rare jewel, but there ARE times when I could have slept - I just didn’t. I spent my time Googling every possible thing that could go wrong, checking her breathing excessively despite having an at-home pulse ox, or laying in bed playing out the worst possible scenario of everything. I pride myself on my vivid imagination and my attention to detail. Those two traits became my worst enemies while the rest of my family slept.

5.I also experienced an irrational fear of extremely low probability situations. For example, I feared that I was so sleep deprived that I would forget my daughter in a particular room or in the car and consequently not remember where. In other words, I was afraid I was so tired that I would lose my daughter in my own home. As I’m typing these words right now, I realize the absurdity of this, but at the time, it was so real and incredibly anxiety provoking. When I finally started driving with her, I needed to check 7 times that she was, in fact, in the back seat. Sound like OCD? That’s because my anxiety presented itself in many ways like OCD does. Again, I had no idea that this was a thing.

What did PPA feel like for you? It feels the way I’d imagine it feels to be swimming in shark-infested water even though I was merely existing in my home. I felt dread. I was ashamed – certain that if anyone found out how I was feeling or what I was thinking they would judge me or my ability to parent. I felt out of control and like I couldn’t trust my own instincts, intuition, or ability to discern true danger from anxious thoughts. Everything felt like a fire alarm.

How did you know something was wrong? My symptoms progressively got worse after the 14 day window of time where baby blues tend to peak and then dissipate. I became more and more isolated and realized that all the things I had dreamed about doing with my baby were now sources of panic attacks. I’d never be able to go to the park with her, because that would require us leaving the house.

Did you seek treatment? I was fortunate to have a wonderful connection to a fantastic therapist who specializes in CBT and Exposure Therapy for anxiety. Exposure Therapy is no joke, but it was incredibly helpful for me!

What causes PPA? That is the million dollar question. We know that as soon as you deliver your baby there is a hormonal shit show that happens, which probably contributes to some cases. There are risk factors (a history of anxiety, depression, or other mood disorders prior to pregnancy), and/or any traumatic experience during pregnancy/labor/delivery. Having a colicky or ill baby is also a risk factor. Additionally, there is an overwhelming sense of responsibility that comes with caring for a tiny human, and that alone can trigger some cases of PPA.

What now? I keep at it. I don’t feel that I’m totally on the other side of it. There are days when keeping my anxiety at bay feels like an uphill battle. I feel like my mind is a dam and the anxiety is the rising water I’m trying to keep out. If the water comes in too fast, I flood or burst. If it doesn’t evaporate regularly, I start to tire (or in my case, check/count/avoid). The good news? I keep getting more resiliant.

When I became a mother, I realized everyone has something to say that can trigger anxious thoughts. "She’s small. She’s unhappy. She’s cold. She’s breathing funny. Is she eating enough? Maybe she needs x, y, or z." In recovering from PPA, I’ve gotten really good at weeding out the bullshit. I’ve started to re-trust my instincts and rebuild my confidence. I’ve started to recognize when someone else is speaking out of their anxiety, and I’m mostly able to tune it out instead of taking water out of their reservoir and adding pressure to my dam.

I’d be lying if I said I’m not terrified that when I have another child I’ll experience this again. Time and time again, I’ve been told that the chances of PPA coming back this strong are slim to none. I’d do pregnancy again. I’d do labor again. I'd do delivery again. My real fear lies in those first days and weeks after the baby arrives. The exhaustion. The hormones. The emotions. The anxiety. I know if I developed PPA again I’d make it. I’d come out on the other side, and I’d rebuild my dam. But it doesn’t mean I don’t consider it every single time we think about having another child. One big advantage I’ll have next time is that I’ll know what I’m up against.